Red eyes and red flags part 1 Flashcards
red flags
multi trauma
red lids and red glove - could be orbital cellulitis or orbital haemotoma
unable to open eye
uveal prolapse
high intraoccqular pressure
what is high intraoocular pressure a red flag for
angle closure glaucoma
presentation of acute angle glaucoma
severe pain vomiting needing opoiods
associated headache
reduced vision
more common in south East Asians
more common in hyperopia
problems affecting lids and lashes
blepharitis, chalazion, stye, cellulitis
why does blephoritis happen during reading/working/driving
you blink less often when your concentration
recent surgery is a red flag for
endopthalmitis
uveal prolapse looks like
very high intraoccular pressur is a red flag for
acute angle glaucoma
previous episodes makes these conditions more likely
uveitis, keratitis, foreign body, seasonality, chalazion/stye
rheumatological disease makes thse conditions more likely
uveitis, episclertis, scleritis, dry eyes (Sjogren’s)
problems affecting the cornea
abrasion, FB, keratitis, chemical injury
recent dental work is a red flag for
orbital cellulitis
is stye is
an infected eyelash follicle
a chalazion is
non infective inflammation
collection of lipid secretion blocks a duct
a fixed mid-dilated pupil with high pressure and pain
angle closure glaucoma
white blood cells in the anterior chamber
uveitis
when to use topical anaesthetics
topical aneasthetic drops: minums oxybupricaine drops
dont put in if there is a globe rupture or penetrating foreign body
infective conjunctivitis aetiology
70% viral
30% bacterial
minority are chlamydia
treatment of chlamydial conjunctivitis
history of unprotected sex
will need swab and azithromycin
blood fluid level in the eye
hyphaema
corneal involvement of conjunctivitis
punctate epithelial erosions
management of conjunctivitis
hand hygiene
simple analgesia, ice packs, artificial tears
+/- conjunctival swab
topical decongestants
no antibiotic unless bacterial, no steroid
VA poor, protracted course, recurrent
do you need antibiotics for normal bacterial conjunctivitis
dont need chlorsig unless severe
leading to antibiotic resistance
do you need topical decongestant
eye can get addicted to it
maybe usee for a patient who has an important event
if you suspect chlamydial conjunctivitis
you have to do a swab
cured with a single dose of azithromycin
microbial keratitis Hx
severe pain, unilateral
reduced vision
hours to days
contact lens wearer or trauma
aetiology of microbial keratitis
mainly gram positive
staph, pseudomonas, acanthomoeba
hypopion
management of microbial keratitis
oral analgesia
urgent ophthalmology referral
remove both contact lenses (save them for culturing)
corneal scrape (with anaesthesia), admission, intensive fortified broad spectrum topical antibiotics
herpetic keratitis Hx
unilateral
associated rash, recurrence
aetiology of herpetic keratitis
HSV1, VZV
UV exposure, concurrent illness, immunosuppression
examination of herpetic keratitis
skin vessicles, shingles rash
Hutchinson’s sign - the tip of the nose is affected
fundoscopy
hutchinson’s sign
lesions on the tip of the nose
management of herpes simplex keratitis
topical antiviral
acyclovir ointment 5x per day
+/- oral acyclovir or valacyclovir
have to catch it within 72 hours for this to be effective
needs to be seen by opthalmology
oral analgesia
management of herpes zoster opthalmicus
oral valacyclovirr for VZV
within 72 hours of onset
+/- topical antibiotic skin cream
referral to ophthalmology
oral analgesia
no steroids
epiphora
watering
corneal abrasion management
urgent referral to opthalmology if infection suspected
topical ABx
oral analgesia +/- patching
follow up within a week
no steroids
removing a foreign body
topical anaesthetic
sterile cotton tip and/or fine gauge needle
ophthalmia burr for rust rings
episcleritis history
red eye +/- discomfort, lacrimation, no discharge
mild to moderate pain
recurrent
may have had a preceding illness
aetiology of episcleritis
idiopathic
metabolic eg. gout
infectious
collagen-vascular / rheumatological condition
usually unilateral main differential is scleritis
management of epislceritis
topical steroids
oral NSAIDs
referral to ophthalmology
review more urgently is you’re worried it’s scleritis
photophobia, cells in the anterior chamber, unusual eye shape
acute anterior uveitis
history of acute anterior uveitis
photophobia, floaters, blurred vision
unilateral, sub-acute
rheumatological disease
aetiology of acute anterior uveitis
ankylosing spondylitis (HLAB27)
idiopathic
inflammatory, infective, malignancy
examination of acute anterior uveitis
limbal injections, AC cells, hypopyan (if it’s really bad)
keratin precipitates, posterior synechiae
pain on examining the unaffected eye (shine a torch into the good eye, pupil constricts on the bad eye causing pain)
management of uveitis
refer to ophthalmology +/- rheumatology (to investigate for underlying rheumatological disease)
sunglasses
investigate for underlying disease
topical steroids (sometimes injected steroids or systemic immunosuppression)
things that are threats to sigh or life
orbital cellulitis
severe trauma
retrobulbar haemorrhage
microbial keratitis
acute angle closure glaucoma
